Nutrition in Cirrhosis - Hepatology Dec 2025

### Nutrition in Cirrhosis and Liver Transplantation:

Cirrhosis is a condition characterized by severe liver dysfunction, often leading to malnutrition, sarcopenia (low muscle mass), and physical frailty. These conditions are prevalent in patients with cirrhosis, affecting 20%–80% of patients with malnutrition, 30%–70% with sarcopenia, and 17%–43% with frailty. Malnutrition and sarcopenia are significant risk factors for poor outcomes, as they reduce functional capacity, impair recovery, and increase the risk of complications both pre- and post-transplant.

### Key Aspects of Nutrition in Cirrhosis:

1. **Nutritional Assessment**:

• It is critical to assess the nutritional status of patients with cirrhosis to identify malnutrition, sarcopenia, and frailty.
• Tools and guidelines should be used to evaluate body composition, muscle mass, and dietary intake.

2. **Nutritional Intervention**:

• Nutritional prehabilitation is essential for patients awaiting LT. This involves optimizing energy intake, protein consumption, and addressing any deficiencies.
• Protein intake is particularly important, as it supports muscle health and combats sarcopenia. Recommendations include distributing protein intake evenly throughout the day and ensuring high-quality protein sources.
• Adequate energy intake tailored to the patient's body mass index (BMI) is necessary to meet their metabolic demands.
• Carbohydrate and fat intake should also be balanced to provide sufficient energy while avoiding complications such as hyperglycemia.

3. **Reassessment and Monitoring**:

• Regular follow-up is critical to monitor progress and adjust nutritional interventions as needed.
• This approach ensures that nutritional strategies remain effective and aligned with the patient's evolving needs.

### Importance of Nutrition in Cirrhosis:

• Proper nutrition can enhance the patient's physiological reserve, improve functional capacity, and reduce the risk of complications during and after LT.
• Malnutrition and sarcopenia, if left unaddressed, can impair the patient's ability to recover from surgery, increase the risk of infections, and prolong hospital stays.

### Summary:

Malnutrition, sarcopenia, and frailty are common in patients with cirrhosis awaiting liver transplantation (LT), significantly impacting postoperative outcomes. Nutritional prehabilitation, a key pillar of multidimensional prehabilitation, involves assessing nutritional status, implementing targeted interventions, and regularly reassessing progress. Recommendations emphasize adequate energy intake, high-quality protein distribution, and addressing deficiencies to improve muscle health and functional capacity. Despite its importance, nutrition in LT prehabilitation remains understudied, with future research needed to refine energy needs, explore dietary supplements, and optimize interventions. Current guidelines advocate proactive nutritional strategies to transform the LT waitlist period into an opportunity for functional improvement.